The big worries on growth hanging over the pharmaceuticals industry are poles apart.

Pressure on U.S. drug pricing is casting a shadow over the sector’s most lucrative market. But slowing emerging-market growth, notably in China, shouldn’t be ignored.

Emerging-market sales for the big pharmaceuticals firms tracked by Sanford C. Bernstein increased by about 5.5%, year over year, in the second quarter, well below the 9% average of the prior four quarters. Macroeconomic pressures are increasing. Weaker currencies hurt sales, a factor put into clear focus by China’s devaluation of the yuan.

Emerging markets account for a big chunk of pharmaceutical revenue, particularly for Europe’s companies. They represent 34% of sales at Sanofi, for example, and 26% at Novartis.

Pharma companies talked up the potential of emerging markets when pipelines were weak and growth elsewhere was lacking. Individual markets aren’t huge; even China generally accounts for only 3% to 5% of revenue, according to Barclays. But relatively limited costs mean good margins on those sales.

And China’s slowdown raises other issues as a large government payer tries to get to grips with a mounting health-care bill.

The shakeout following GlaxoSmithKline’s bribery scandal in 2013 continues: Both sales teams and doctors are more cautious. In some cases, this is helping encourage prescribers to choose cheaper and reimbursed alternatives, says Jakob Riis, head of China at Novo Nordisk, rather than more modern, valuable drugs like Novo’s Victoza that aren’t on hospital formularies but sold to patients in pharmacies.

More broadly, China’s market is starting to change. Some companies in the second quarter seemed more reliant on sales of new products. Bayer, for example, reported growth there of 6%, against its full-year target of 10%. It said the main contributor to growth was sales of new blood thinner Xarelto. It may be getting tougher to make easy money pushing out older but still relatively pricey drugs to a vast, underserved population.

Meanwhile, there is little doubt the Chinese government has started to crack down on health-care spending. Even where drugs have already made it onto approved lists, buyers can use those prices as the starting point for a second round of bidding. That comes alongside targets mandating that hospitals get drug spending to under a set percentage of their total budget. At about 40% currently, China’s drug spend is very high compared with the international norm of 15% to 25%, notes Bernstein.

Incentives that pushed Chinese hospitals toward overprescribing or selecting dearer medicines are being removed. Hospitals previously added a markup to drug prices, paid by insurance schemes or patients, which helped their budgets. That has now been banned. A cost-conscious atmosphere could favor local companies or generics in some therapeutic areas, rather than international brands.

Anxiety over slower-growing emerging markets is unlikely to lift quickly. In China’s case, however, weaker sales numbers may be the start of a longer structural adjustment, rather than simply a cyclical dip.